Referral Process Consideration for Physical and/or Occupational Therapy Services
1. The person initiating the Physical or Occupational Therapy referral must complete all parts of the referral form. The student must currently meet the criteria for Section 504 services. 2. The consent for Evaluation form must be signed and dated by the parent. 3. Once completed, the Physical or Occupational Therapy referral form and Consent for Evaluation must be sent to the Section 504 Coordinator. 4. The Physical or Occupational Therapy evaluation is assigned to the therapist. 5. The physical or occupational therapist will schedule an evaluation with the campus. 6. The therapist will complete the assessment, provide a written report to the SAISD 504 Coordinator, and then notify the school of its completion. 7. The District 504 Coordinator will review and sign off on the services recommended. The 504 evaluation is sent to the campus from the District 504 office. 8. The campus designee will schedule a Section 504 committee meeting to review the evaluation findings and make recommendations. The therapist must attend that meeting. 9. The Section 504 committee determines if the student qualifies for related services. The therapist will recommend to the committee the type, frequency, duration, and location of services to be provided. Recommended goals and objectives for physical or occupational therapy services will be presented for consideration at the Section 504 committee meeting.
San Antonio Independent School District
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Section 504 Services. July 2004
Physical Therapy Referral Person Originating Request: ______________________________ Phone: _________________ Date: __________________ School: _____________________________ NOTE: A signed Receipt of Rights and Notice, Consent for Initial Section 504 Evaluation, and Section 504 Evaluation forms must accompany the completed referral form. STUDENT INFORMATION Student: __________________________________ DOB: __________ ID: _______________ 504 Eligibility: _________________________________________________________________ If student is a transfer student with PT services recommended by Section 504, what is the frequency and duration? __________________________________________________________ EDUCATIONAL CONCERNS A Physical Therapy Referral may be appropriate if one or more of the following is checked: 1. The student appears to have physical problems getting from one location to another in school. _____ Has a wheelchair _____ Requires a device or physical assistance to walk _____ Does not have independent mobility on steps/stairs 2. The student appears to have problems getting form one surface to another. _____ Cannot stand without help _____ Has physical difficulty getting up from the floor _____ Requires assistance to move from one seat to another, e.g. wheelchair to toilet 3. The student appears to need positioning assistance. _____ Cannot sit for activities without support _____ Cannot physically stand for activities without support
List current learning that is being hindered: 1. ___________________________________________________________________________ 2. ___________________________________________________________________________ 3. ___________________________________________________________________________ Please send this form and above noted documents to Section 504 Coordinator.
San Antonio Independent School District
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Section 504 Services. July 2004
Occupational Therapy Referral Person Originating Request: ______________________________ Phone: _________________ Date: __________________ School: _____________________________ NOTE: A signed Receipt of Rights and Notice, Consent for Initial Section 504 Evaluation, and Section 504 Evaluation forms must accompany the completed referral form. STUDENT INFORMATION Student: __________________________________ DOB: __________ ID: _______________ 504 Eligibility: _________________________________________________________________ If student is a transfer student with OT services recommended by Section 504, what is the frequency and duration? __________________________________________________________ EDUCATIONAL CONCERNS An Occupational Therapy Referral may be appropriate if one or more of the following is checked: 1.
The student exhibits difficulty with motor or perceptual skills, which interfere with educational performance. Instructional Activities _____ handling materials and manipulatives _____ poor cutting skills _____ poor pasting/gluing skills Handwriting _____ poor pencil/crayon use _____ slow writing _____ incomplete assignments _____ illegible writing _____ physically cannot write 2. The student exhibits deficient job skills. Prevocational _____ poor work habits/organizational skills _____ physical abilities limit performance _____ social skills limit performance
3.
The student exhibits difficulty with self-help skills. Eating _____ has difficulty chewing or drinking: carrying tray, opening milk carton _____ has difficulty using eating utensils
Dressing _____ does not have age appropriate skills _____ has difficulty with clothing management during toileting _____ needs suggestions for alternative techniques 4.
The student has difficulty with other areas as related to occupational therapy.
_____ _____________________________________ _____ _____________________________________ _____ _____________________________________
List current learning that is being hindered: 4. ___________________________________________________________________________ 5. ___________________________________________________________________________ 6. ___________________________________________________________________________ Please send this form and above noted documents to Section 504 Coordinator.
San Antonio Independent School District
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Section 504 Services. July 2004
Definitions for Direct Service and Consultation
Direct Service: As defined by the Executive Council of Physical Therapy and Occupational Therapy Examiners: Direct service…refers to the provision of occupational therapy services to individuals to develop, improve, and/or restore functioning. The direct student service component of the collaborative model is a discipline specific service provided by the occupational therapist. These services are provided when implementation of the student’s goals requires the discipline specific skills of the therapist. Direct services may be provided to individuals or small groups. This component requires supplemental consultative services to ensure generalization of student’s skills to other settings.
Consultation: As defined by the Executive Council of Physical Therapy and Occupational Therapy Examiners: Consultation… (is) the provision of an occupational therapist’s expertise to an individual or institution. This service may be provided on a one time only basis or on an ongoing basis. Consultative student services include two goals: First, the consultant seeks to create solutions that remediate the presenting problems. Second, the consultant seeks to increase others’ skills, so that they can respond more effectively to similar problems in the future. Consultative services may be given to students, staff, families, and administration. Consultative services may be appropriate for the following areas: educationally related activities, assistive technology, adaptive materials, and when emphasis is on accommodations to learning environment.
San Antonio Independent School District
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Section 504 Services. July 2004
Dismissal Process Physical and Occupational Therapy Services
1. Obtain a current Permission to Test form signed by parent. 2. Perform evaluation to determine if student no longer needs physical or occupational therapy services as a necessary related service. One of the following dismissal criteria must be met for dismissal: Occupational Therapy Goals or outcomes requiring occupational therapy have been met and no additional ones are appropriate, Potential for further change as a result of occupational therapy services appears unlikely, Problem ceases to be educationally relevant, Therapy is contraindicated due to medical, psychological or social complications Physical Therapy Student has not experienced an advancement of skill level despite receiving physical therapy services, Student is independent with gross motor skills 3. Re-evaluation report written 4. Report presented at Section 504 committee meeting 5. Dismissal from services with Section 504 committee agreement
San Antonio Independent School District
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Section 504 Services. July 2004
SAN ANTONIO INDEPENDENT SCHOOL DISTRICT DYSLEXIA/504/SST STUDENT ELIGIBILITY FOLDERS TRANSMITTAL FORM FROM: _______________________________ Sending School
STUDENT NAME
ID NUMBER
TO: ________________________________ Receiving School TYPE OF FOLDER
DISABILITY
DATE OF LAST ANNUAL REVIEW
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12 13.
______________________________________
__________________________________
Signature of Sending Principal
Signature of Receiving Principal
_____________________
_____________________
Date
Date
San Antonio Independent School District
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Section 504 Services. July 2004
Physical Therapist Job Description Job Goal: To enhance the special needs student’s ability to function as independently as possible in the educational setting. Qualifications: 1. Current licensure as a Physical Therapist by the Texas Executive Council of Physical Therapy and Occupational Therapy Examiners 2. Bachelor or Master’s degree from an accredited Physical Therapy program 3. clinical experience in the pubic school and/or pediatric setting is preferred 4. Demonstrated communication skills – written and oral 5. Management style compatible with the position Performance Responsibilities: 1. Assess student’s current functional level, interpret results of testing and educational needs, determine eligibility for Physical Therapy services, and recommend type and frequency of services and changes in service requirements to the Section 504 committee 2. Follow established procedures for referral process, including physician referral, providing evaluation and annual written reports as required, participating in Section 504 committee meetings and determining eligibility and service delivery. 3. Deliver physical therapy services which may include (but are not limited to) the following areas: mobility, transfer skills, gross motor skills, posture and movement, endurance, adaptive equipment, and adaptations needed in instructional settings for eligible students 4. Provide district-wide training and individual student related training to personnel who have an educational interest in the student 5. Implement professional judgment and practices as outlined by the American Physical Therapy Association (APTA) 6. Perform other duties as assigned Job Demands: 1. Observational ability: to be able to observe a student accurately from a distance and close at hand to assess educational based gross motor needs 2. Communication: to be able to effectively communicate physical therapy concepts to the nonmedical audience 3. Motor ability: to be able to perform gross and fine motor movements required to provide physical therapy services in a timely manner. Examples of movements to be performed – lifting and transferring students, handling adaptive equipment and providing services in a number of different geographic settings 4. Critical thinking: to be able to problem-solve and adapt to a changing environment 5. Interpersonal ability: to be able to work effectively with individuals from a variety of social, emotional, cultural and intellectual backgrounds
San Antonio Independent School District
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Section 504 Services. July 2004
Physical Therapist Responsibilities 1. Implement gross motor/physical therapy objectives while implementing professional judgment and practices as outlined by the American Physical Therapy Association (APTA). 2. Review the Section 504 eligibility folder for each student who is qualified for, or who is referred for, physical therapy services for an understanding of the student’s gross motor needs. 3. Evaluate student and consult with staff and parent regarding gross motor needs. 4. Prepare physical therapy written evaluation and contact counselor or campus designee to schedule Section 504 meeting, as needed. 5. Attend Section 504 committee meetings to interpret evaluation and make recommendations for needed physical therapy services and gross motor objectives. 6. Implement physical therapy service plan. Document services in intervention notes including time, type of service and attendance on log for services form. Send physical therapy progress notes to campus for eligibility folder and parent each nine weeks. 7. Maintain communication that is respectful with students, parents and campus staff. 8. Update Physical Therapy Annual Report, Student Eligibility Report, and gross motor objectives annually. 9. Participate in Triennial Review for student eligibility for physical therapy services. 10. Maintain current licensure, including required continuing educational units (CEU’s) according to the Texas Executive Council of Physical Therapy and Occupational Therapy Examiners. 11. Maintain inventory of assigned gross motor adaptive equipment. 12. Provide staff training on transfers, positioning, mobility, accessibility, and safety concerns for students eligible for physical therapy services. 13. Participate in district and departmental staff development programs. 14. Follow policies and procedures established by the San Antonio Independent School District. 15. Follow and implement district and department End-of-Year Procedures.
San Antonio Independent School District
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Section 504 Services. July 2004
Physical Therapy as a Related Service All physical therapy services will be integrated into the student’s instructional setting. Therapy interventions may follow a consultation and/or direct therapy service model. They may be provided on an individual basis, in a group setting, and/or in consultation with the instructional staff. The following information describes the services provided by the physical therapist and how these services relate to the educational program.
Functional Area
Relationship to Education
Functional Mobility
To provide student’s safe mobility within the educational environment
Environmental Adaptations
To facilitate the student’s access within the educational environment
Positioning
To provide the student the optimal position for learning and participation in the educational program
San Antonio Independent School District
Physical Therapy Services Assist student with safe mobility, positioning and transfer skills with or without equipment. This may include transfers to the toilet or changing table, ascending stairs, etc. Provide recommendations for accommodations, adaptive equipment, and removal of architectural barriers. This may include arrangement of restroom equipment for wheelchair access, providing height-adjustable desks to accommodate wheelchair, and providing consultation on use of assistive technology to benefit from educational program. Provide instruction in positioning with adaptive equipment, handling methods, energy conservation techniques, skin care, splints and braces within the educational program. This may include handling and positioning during toileting, recommending alternate positions to relieve pressure and recommending amount of wheelchair tilt to conserve energy.
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Section 504 Services. July 2004
Clinical Therapy vs. School-Related Physical Therapy
We must understand that schools are required to provide only those services which are educationally relevant (i.e., that assist a student such that he/she can benefit from their educational program). The medical needs of that student may continue upon entry into the educational system and should be met by the medical community (i.e., outpatient or home health physical therapy).
Clinical Therapy Based on a medical model Threat the medical cause or the symptom Therapy goals are primary Treat acute conditions Focus is on developmental milestones and components of movement Few responsibilities are delegated except to parents Therapist provides direction intervention Hospital, clinic, or home setting Physician prescription required
San Antonio Independent School District
School-Related Therapy Related service based on educational need Help the student’s function(s) in order to benefit from the educational program Educational goals are primary Reduce effects of chronic conditions so the student can benefit from the educational program Focus in on functional skills and adaptations that promote the attainment of instructional objectives More responsibilities are delegated to parent and staff Therapist provides direct intervention or consults with educational staff in order to follow the therapist’s recommendations Public school setting May need physician prescription, however, student must qualify for physical therapy services based on educational need and Section 504 committee evaluation
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Section 504 Services. July 2004
Occupational Therapist Job Description Job Goal: To provide occupational therapy as a related service to assist eligible students as required for the students to benefit form Section 504 support. Qualifications: 1. Current licensure as a Licensed Occupational Therapist by the Executive Council of Physical Therapy and Occupational Therapy Examiners 2. Bachelor or Masters degree from a university with an accredited OT program 3. Clinical experience in the public school, annex, or pediatric setting 4. Demonstrated communication skills – written and oral 5. Management style compatible with the position Performance Responsibilities: 1. Assess student’s current functional level, interpret results, determine educationally necessary needs and eligibility for OT services, recommend type and frequency of services and changes in service requirements to the Section 504 committee 2. Provide educationally necessary occupational therapy services as directed by the Section 504 committee 3. Follow established procedures for obtaining an occupational therapy referral from an educational setting, obtaining physician referral as indicated, producing evaluation and annual written reports as required, participating in Section 504 committee meetings, determining eligibility, and service delivery 4. Deliver occupational therapy services which may include (but are not limited to) the following areas: gross motor skills, fine motor skills, self care skills, use of classroom tools, visual motor and perceptual skills, posture and movement, adaptive equipment and assistive devices to allow the student to function in the academic setting 5. Provide in-service training as needed to district staff and individual student related training to personnel who have an educational interest in the child 6. Assist with the ordering of equipment and adaptive devices as needed 7. Implement professional judgment and practices as outlined by the American Occupational Therapy Association (AOTA), Council on Standards and Practice, and the Texas Board of Occupational Therapy Examiners. 8. Submit all required paperwork in a timely manner. Job Demands: 1. Observational ability: To be able to observe a student accurately in order to assess educational needs as related to OT 2. Communication: To be able to effectively communicate in language that relates occupational therapy concepts to the non-medical audience. 3. Motor ability: Top be able to perform gross and fine motor movements required to provide occupational therapy services in a timely manner. Examples of movements: perform lifting and transferring students, handling adaptive equipment, providing services in a number of different geographic settings on a daily basis 4. Critical thinking ability: To be able to problem-solve and adapt to changing environment 5. Interpersonal ability: To be able to work effectively with individuals from a variety of social, emotional, cultural and intellectual backgrounds San Antonio Independent School District
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Section 504 Services. July 2004
Occupational Therapist Responsibilities 1. Complete OT frequency of services adopted within the Section 504 plan. 2. Work with student and staff to accomplish individual objectives through direct and consultative services. 3. Complete and present an annual report to the Section 504 committee to document progress and change objectives, as needed. 4. Communicate progress of student to parent through progress reports. 5. Evaluate equipment needs for the student and facilitate the procurement of the appropriate equipment. 6. Provide training for school staff on such things as safety and handling of students. 7. Inform campus and Section 504 department of unsafe accessibility issues. 8. Facilitate meeting the educationally related needs of the student by communicating with parents, doctors, teachers, agencies, etc. 9. Complete required paperwork associated with each student in a professional and timely manner. 10. Make initial contact with each school within the first two weeks of the school year. 11. Complete log of services to document intervention visits for every student. 12. Maintain OT working folders to contain the following: Consent for evaluation, evaluation, annual and progress reports, physicians’ referrals, consents for release of information (if requested), and prior year’s contact logs. 13. Transfer working folders of students going to another therapist’s campus within one week of notice. Ensure all documents listed in #12 are included in the folder. If the student moves out of the district, file the working folder in the Section 504 office. 14. Follow transfer of equipment process and procedure. 15. Maintain equipment inventory.
San Antonio Independent School District
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Section 504 Services. July 2004
Occupational Therapy as a Related Service Occupational Therapists use purposeful activities and adaptations to assist students in achieving their highest level of functional independence as it relates to the student’s educational needs. In the educational setting, occupational therapy (O.T.) services may be provided only when those services are necessary for eligible Section 504 students to benefit from their individual educational plan. Occupational therapy services will be integrated into a student’s instructional setting. The interventions may follow a consultation and/or direct therapy service model provided on an individual basis, in a group setting, and/or in consultation with the instructional staff. The following describes the services and how these services relate to the educational program. Functional Area Relationship to Education Occupational Therapy Services To allow the student as much Enhance self-care, mobility and transfer skills, independence as possible to which may include adaptive equipment for Self-Help function in the educational grooming, hygiene, dressing and feeding setting Recommend techniques, supplies or To enable the student to handle accommodations (i.e., assistive technology) to classroom manipulatives and facilitate fine motor tasks, which may include Fine Motor complete written classroom specialized scissors, handwriting strategies and work in appropriate time-frames specialized software Provide recommendations for accommodations To facilitate the student’s access and adaptive equipment, which may include Environmental consultation and/or training on the use of the within the educational Adaptations assistive technology used to support educational environment program To provide the student the Provide recommendations for positioning optimal position for learning needed throughout the school day, which may Positioning and participation in the include meal time and table top activities educational program NOTE: Based on an OT evaluation, if a problem is not interfering with the student’s ability to participate in the educational program, then the problem is not educationally relevant and would not constitute a need for OT.
Clinical vs. School-Related Occupational Therapy Clinical Therapy
School-Related Therapy
Based on a medical model Treats the medical cause or the symptom Therapist provides direct intervention Hospital, clinical or home setting Prescription or referral from a licensed referral source is usually required
San Antonio Independent School District
Based on educational need Assists the student so he/she can function well enough to benefit from the educational program Therapist provides direct intervention or consults with the educational staff so they can follow the therapist’s recommendations Public school setting May need a physician’s prescription, however, the student must qualify for services based on educational need through the Section 504 evaluation and Section 504 committee decision
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Section 504 Services. July 2004
